B. Drug users vulnerability to HIV/AIDS

Drug use has serious social and health consequences. The
majority of drug users in Asia are extraordinarily poor and often jobless or
relegated to doing odd jobs. Homelessness is widespread. Many of them beg,
borrow, or even steal. They are criminalized, stigmatized, and discriminated
against. Such factors, combined with low self-esteem and little trust in
authorities, make drug users a population to which traditional health and social
services have little access.

Social consequences of drug use

Source: AHRN Clearing-house

The health status of drug users, particularly that of injecting
drug users, is a matter of great concern: blood borne diseases such as hepatitis
and HIV infection, abscesses and serious wounds from inadequate injecting
equipment, and death from overdose are common. With the onset of the HIV/AIDS
epidemic in the late 1980s, drug use in Asia entered an even more serious phase
and became a major public health concern. Drug use has an intricate relationship
with HIV/AIDS: HIV is transmitted through the sharing of contaminated needles
and syringes and other equipment employed by drug users. In addition, alcohol
and stimulant abuse often lower resistance to high-risk behaviour such as
unprotected sexual intercourse.

Social consequences of drug use

Source: AHRN Clearing-house

Table 1. Drug use in selected countries of Asia
(estimates)

Country

Drug users (000s)

Opiate users (000s)

% injectors

% drug users among HIV+

% HIV+ among drug users

Bangladesh

500-1,000

N/E

10-17

N/E

2.5

China

540

majority

66

69.4

40.5

India

2,250

500

25-90

N/E

1.3-68.4

Malaysia

300

200

50

77.0

10-27

Myanmar

300

majority

30

20-30

65.5-72.5

Nepal

30-50

majority

74.8

12.6

49.7

Pakistan

3,000

1,500

1.8-29

N/E

0.4-1.8

Sri Lanka

240

40

7.5

N/E

N/E

Thailand

1,270

219

60

5.25

30-40

Viet Nam

185

majority

no data

65.5

13.5-64.0

N/E = no estimates

Source: Regional Task Force on Drug Use and HIV
Vulnerability, Drug Use and HIV Vulnerability Policy Research
Study

Drug users in Asia are highly vulnerable to HIV transmission
because of the legal, political, socioeconomic, health service, and cultural
situations in which they live. These situations, however, vary considerably from
country to country, even from community to community in the same country. In
many countries of Asia, as elsewhere in the world, drug policies are highly
politicized and are influenced by historical, social, religious, cultural, and
economic factors. Strongly held beliefs about drugs and their adverse effects on
the society, national experiences with drug use in the past, the extent and
seriousness of past and present drug problems, and the interpretation of
international conventions all have an impact on the development of policies and
legal instruments directed at drug use.

In a number of countries, the law prescribes severe punishments
for all drug-related offences including not only drug use but also possession of
drugs and drug-use paraphernalia (e.g. needles and syringes). The level of
penalties and the stringency with which they are applied locally affect the
feasibility of preventive interventions for drug users. Indeed, these penalties
may actually preclude providing drug users with information or with the means to
protect themselves against HIV infection.

Drug-use practices contribute significantly to the vulnerability
of drug users. Many drug users in the region use narcotics such as opium and
heroin, and a significant percentage inject. In some countries injecting drug
users go to secluded shooting galleries, but in other countries injecting takes
place in more public locations: in a designated area users can get an injection
from a dealer or person whose job it is to inject users. In most cases, dealers
and public injectors have little or no information about HIV infection. The
sharing of needles, syringes, and other drug-use equipment is common.

Social consequences of drug use

Source: AHRN Clearing-house

In addition to sharing needles and syringes, the sexual
practices of drug users is another important area that contributes to their
vulnerability to HIV infection. Drug users tend to be sexually active, and their
condom use is often very low. In some countries, condoms are often used in sex
with commercial sex workers but not with regular partners. Unprotected sex is
often perceived to be less risky than sharing needles and syringes. A high
prevalence of sexually transmitted infections among drug users reflects their
unsafe sexual practices. They and their partners often act as a bridge to
transmit HIV to other populations such as commercial sex workers, clients of
commercial sex workers, and then to the general population.

The HIV/AIDS epidemic began to spread in Asia in the late 1980s.
In a number of countries - China, Myanmar, Nepal, Thailand, and Viet Nam - drug
users were the first to be infected; the epidemic then spread from drug-using
populations to other groups, and from there to the general population.

Treatment and rehabilitation centres are often not readily
available to drug users. In many countries, services provide detoxification
only, or treatment is mandatory and carried out in a military style with a
strong penal element to achieve total abstinence - strong reasons for drug users
to avoid attending. In many regions of Asia, outpatient and substitution
treatment as well as aftercare services are virtually absent. If services are
available, they are often provided by non-specialists with limited knowledge
about drug treatment and HIV/AIDS
prevention.